Tumour 18 F-FDG Uptake on preoperative PET/CT may predict axillary lymph node metastasis in ER-positive/HER2-negative and HER2-positive breast cancer subtypes.

OBJECTIVES: To evaluate the association between tumour FDG uptake on preoperative PET/CT and axillary lymph node metastasis (ALNM) according to breast cancer subtype. METHODS: The records of 671 patients with invasive breast cancer who underwent (18) F-FDG PET/CT and surgery were reviewed. Using immunohistochemistry, tumours were divided into three subtypes: oestrogen receptor (ER)-positive/human epidermal growth factor receptor 2 (HER2)-negative, HER2-positive, and triple-negative. Tumour FDG uptake, expressed as maximum standardized uptake value (SUVmax), and clinicopathological variables were analysed. RESULTS: ALNM was present in 187 of 461 ER-positive/HER2-negative, 54 of 97 HER2-positive, and 38 of 113 triple-negative tumours. On multivariate analysis, high tumour SUVmax (≥4.25) (P < 0.001), large tumour size (>2 cm) (P = 0.003) and presence of lymphovascular invasion (P < 0.001) were independent variables associated with ALNM. On subset analyses, tumour SUVmax maintained independent significance for predicting ALNM in ER-positive/HER2-negative (adjusted odds ratio: 3.277, P < 0.001) and HER2-positive tumours (adjusted odds ratio: 14.637, P = 0.004). No association was found for triple-negative tumours (P = 0.161). CONCLUSIONS: Tumour SUVmax may be an independent prognostic factor for ALNM in patients with invasive breast cancer, especially in ER-positive/HER2-negative and HER2-positive subtypes, but not in those with triple-negative subtype. KEY POINTS: • Tumour SUVmax could be an imaging biomarker for predicting ALNM • Tumour SUVmax predicting ALNM is effective in ER-positive/HER2-negative and HER2-positive subtypes • Tumour SUVmax predicting ALNM is inaccurate in triple-negative subtypes • Accurate prognostic prediction based on molecular subtype may facilitate individualized management.

The Breast Tumor Strain Ratio Is a Predictive Parameter for Axillary Lymph Node Metastasis in Patients With Invasive Breast Cancer.

OBJECTIVE: The purpose of this study was to evaluate the association between the breast tumor strain ratio and axillary lymph node metastasis in patients with invasive breast cancer. MATERIALS AND METHODS: The records of 284 patients with invasive breast cancer who underwent ultrasound elastography before surgery between March 2013 and May 2014 were reviewed retrospectively. For women with multifocal or bilateral cancer, the largest tumor was included. An experienced radiologist performed ultrasound elastography and measured the strain ratio, which is defined as the fat-to-lesion ratio and is indicative of the relative stiffness of the breast lesion, using dedicated software within the ultrasound equipment. The associations between axillary lymph node metastasis with the tumor strain ratio and clinical and biologic variables were evaluated using univariate and multivariate logistic regression analyses. RESULTS: Among 284 tumors, 85 (29.9%) showed axillary lymph node metastasis by surgical histopathologic analysis. The strain ratio was statistically significantly higher in tumors with axillary lymph node metastasis than in those without axillary lymph node metastasis (mean ± SD, 5.19 ± 1.28 vs 4.17 ± 1.30, respectively; p < 0.001). On univariate analysis, a higher strain ratio (> 3.89), larger tumor size (> 2 cm), higher histologic grade (grade 3), presence of lymphovascular invasion, palpability, and higher expression of Ki-67 (≥ 14%) were statistically significantly associated with axillary lymph node metastasis. On multivariate analysis, a higher strain ratio (> 3.89) (odds ratio [OR], 14.208; p < 0.001), presence of lymphovascular invasion (OR, 17.437; p < 0.001), and higher expression of Ki-67 (≥ 14%) (OR, 3.744; p = 0.002) maintained independent significance for predicting axillary lymph node metastasis. CONCLUSION: The breast tumor strain ratio on ultrasound elastography is associated independently with axillary lymph node metastasis in patients with invasive breast cancer.

Preoperative 18F-FDG PET/CT predicts disease-free survival in patients with primary invasive ductal breast cancer.

BACKGROUND: Previous studies have correlated the maximum standardized uptake value (SUVmax) of breast cancer lesions with histological and biological characteristics such as tumor size, histologic grade, or hormonal receptor expression status. However, controversy remains concerning the prognostic value of SUVmax in breast cancer. PURPOSE: To determine if the SUVmax of a tumor on 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) is associated with disease-free survival in patients with primary invasive ductal breast cancer. MATERIAL AND METHODS: The institutional review board of our hospital approved this retrospective study. From 2009 to 2011, 508 women (mean age, 53.6 years; age range, 26-85 years) with newly diagnosed invasive ductal breast cancer who had undergone preoperative 18F-FDG PET/CT followed by surgery were identified. Clinicopathological variables and FDG uptake quantified by SUVmax were analyzed. The Cox proportional hazards model was used to evaluate the association between SUVmax and disease-free survival after controlling for clinicopathological parameters. RESULTS: There were 21 recurrences at a median follow-up of 46 months. The mean SUVmax of the primary tumor was significantly higher in patients with a recurrence than those who remained disease-free (9.5 ± 3.5 vs. 6.6 ± 4.2, P < 0.001). A receiver operating characteristic curve indicated that a SUVmax of 5.95 was the optimal cut-off value to predict disease-free survival. Multivariate analysis identified a high SUVmax (≥5.95) and high T stage as independent significant variables associated with worse disease-free survival. CONCLUSION: A high primary tumor SUVmax on 18F-FDG PET/CT was an independent factor associated with worse disease-free survival in patients with primary invasive ductal breast cancer.

Magnetic resonance imaging characteristics of invasive breast cancer in women aged less than 35 years.

BACKGROUND: With regard to clinicopathological findings and disease prognosis, breast cancer in young women is different from that in older women. However, few studies have investigated magnetic resonance imaging (MRI) characteristics of young age-onset breast cancer. PURPOSE: To retrospectively evaluate and compare the MR images and clinicopathological characteristics of invasive breast cancer in young women (aged <35 years) with those of breast cancers in older premenopausal women (35-45 years). MATERIAL AND METHODS: A total of 270 invasive breast cancers in 266 premenopausal women aged 45 years and younger who underwent preoperative breast MRI and curative surgery were identified between 2009 and 2013. The subjects were divided into a young group (< 35 years, n = 56) and an older group (35-45 years, n = 214). MRI features and clinicopathological data were compared between the two groups. RESULTS: The young group had more positive axillary lymph nodes, higher histologic grade, negative estrogen receptor (ER), negative progesterone receptor (PR), and higher p53 and Ki-67 expression compared to the older group. Using MRI, the young group was more likely to display a round/oval or lobular mass shape, a smooth mass margin, and a high signal intensity on T2-weighted images when compared to the older group. In multivariate analysis, positive axillary nodal status (adjusted odds ratio [OR], 4.070; P = 0.002), higher expression of p53 (adjusted OR, 2.902; P = 0.038), lobular mass shape (adjusted OR, 4.979; P = 0.028), and smooth mass margin (adjusted OR, 5.123; P = 0.048) were independently associated with the young group. CONCLUSION: MR morphologic features, including lobular mass shape and smooth mass margin, were independently associated with breast cancer in young women, in addition to positive axillary nodal status and higher p53 expression status.

Hepatic capsular and subcapsular pathologic conditions: demonstration with CT and MR imaging.

A variety of pathologic conditions and pseudolesions occur at the capsular and subcapsular regions of the liver and are detected with cross-sectional abdominal imaging. These entities are related to anatomic and hemodynamic characteristics of the liver such as negative subdiaphragmatic pressure, connection with other viscera and extraperitoneal sites by the perihepatic ligaments, and a "third inflow" of blood from sources other than the usual hepatic arterial and portal venous sources. Pathologic conditions can affect the hepatic capsular and subcapsular regions by way of peritoneal, hematogenous, biliary, and perihepatic ligamentous routes. Pseudolesions or benign conditions may also be identified on the basis of altered hemodynamics of the liver. Computed tomography and magnetic resonance imaging with a multiphasic approach can be used to identify and characterize these entities. Familiarity with the wide spectrum of pathologic conditions and pseudolesions at the hepatic capsular and subcapsular regions and precise knowledge of the anatomic and hemodynamic characteristics of the liver will aid the radiologist in diagnosing pathologic conditions and differentiating pseudolesions from true lesions.

CT evaluation of the bulging papilla with endoscopic correlation.

A variety of pathologic conditions can cause abnormalities of the ampulla of Vater. A bulging papilla is frequently encountered at computed tomography (CT) and can be seen in healthy individuals as well as in patients with various pathologic conditions such as papillitis, ampullary cancer, and intraductal papillary mucinous tumor. Mural thickening and certain attenuation patterns seen at contrast material-enhanced CT can help differentiate pathologic papilla from normal papilla. Increased targetlike enhancement of the papilla is likely to represent a benign condition such as papillitis, whereas an enhancing polypoid mass or focal asymmetric or irregular thickening with prolonged enhancement in the ampulla of Vater indicates a malignant condition such as ampullary or periampullary carcinoma. Although CT often does not clarify the exact cause of bulging, adequate duodenal distention may allow detection of an abnormal papilla, thereby providing additional information about other abnormalities in the pancreaticobiliary system. Thus, CT findings may prove useful for subsequent imaging studies such as magnetic resonance (MR) cholangiography or endoscopy. MR cholangiography may be equivalent to CT for identifying a bulging papilla and superior for distinguishing the underlying cause. However, endoscopy with or without biopsy is the best method for making a definitive diagnosis in patients with a bulging papilla. Familiarity with the normal imaging anatomy of the periampullary region and with the imaging features of the various pathologic causes of a bulging papilla may be useful in making the diagnosis.

The perihepatic space: comprehensive anatomy and CT features of pathologic conditions.

The liver is covered by visceral peritoneum except at the bare area, bed of the gallbladder, and porta hepatis. The investing peritoneum becomes contiguous with the adjacent structures such as the diaphragmatic peritoneum, lesser omentum, and ligamentum teres. An inflammatory process or tumors involving the perihepatic space are usually affected by intraperitoneal flow dynamics, which depend on the anatomy of the recess as well as gravity and negative subdiaphragmatic pressure. Pathologic conditions that occur in the perihepatic space include abnormal air, fatty masses, conditions producing fluid attenuation at computed tomography (CT), and soft-tissue masses. Enhancement of the hepatic capsule indicates inflammation, as is seen in Fitz-Hugh-Curtis syndrome. The perihepatic ligaments may be invaded by various conditions by means of direct invasion, subperitoneal extension, or extension along the lymphatic vessels. Knowledge of the normal anatomy of the perihepatic space together with the clinical history and characteristic features at CT can assist the radiologist in making the correct diagnosis.